Provider Demographics
NPI:1235650003
Name:LAHAM, GRANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:LAHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 E 21ST ST N APT 412
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3525
Mailing Address - Country:US
Mailing Address - Phone:316-209-0474
Mailing Address - Fax:
Practice Address - Street 1:10351 MASTIN ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:316-209-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS614381223G0001X, 1223G0001X
TX334631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice